Hippocampal Damage During Mechanical Ventilation in Trendelenburg Position: A Secondary Analysis of an Experimental Study on the Prevention of Ventilator-Associated Pneumonia.

Autor: López-Aguilar J; Critical Care Center, University Hospital Parc Taulí, Sabadell, Universitat Autonoma de Barcelona, Barcelona, Spain.; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Institut d'Investigació i Innovació Parc Taulí (I3PT), Fundació Parc Taulí, Sabadell, Spain., Bassi GL; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain.; University of Barcelona, Barcelona, Spain., Quílez ME; Critical Care Center, University Hospital Parc Taulí, Sabadell, Universitat Autonoma de Barcelona, Barcelona, Spain.; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Institut d'Investigació i Innovació Parc Taulí (I3PT), Fundació Parc Taulí, Sabadell, Spain., Martí JD; Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain., Ranzani OT; Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain., Xiol EA; Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain., Rigol M; Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain., Luque N; Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain., Guillamat R; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Institut d'Investigació i Innovació Parc Taulí (I3PT), Fundació Parc Taulí, Sabadell, Spain., Ferrer I; Departament de Patologia i Terapèutica Experimental, Universitat de Barcelona, Barcelona, Spain.; Hospital Univesitari de Bellvitge-Idibell, Barcelona, Spain.; CIBERNED, Instituto Carlos III, Hospitalet de Llobregat, Barcelona, Spain., Torres A; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Barcelona, Spain.; University of Barcelona, Barcelona, Spain., Blanch L; Critical Care Center, University Hospital Parc Taulí, Sabadell, Universitat Autonoma de Barcelona, Barcelona, Spain.; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Institut d'Investigació i Innovació Parc Taulí (I3PT), Fundació Parc Taulí, Sabadell, Spain.
Jazyk: angličtina
Zdroj: Shock (Augusta, Ga.) [Shock] 2019 Jul; Vol. 52 (1), pp. 75-82.
DOI: 10.1097/SHK.0000000000001237
Abstrakt: We previously corroborated benefits of the Trendelenburg position in the prevention of ventilator-associated pneumonia (VAP). We now investigate its potential effects on the brain versus the semirecumbent position. We studied 17 anesthetized pigs and randomized to be ventilated and positioned as follows: duty cycle (TI/TTOT) of 0.33, without positive end-expiratory pressure (PEEP), placed with the bed oriented 30° in anti-Trendelenburg (control group); positioned as in the control group, with TI/TTOT adjusted to achieve an expiratory flow bias, PEEP of 5 cm H2O (IRV-PEEP); positioned in 5° TP and ventilated as in the control group (TP). Animals were challenged into the oropharynx with Pseudomonas aeruginosa. We assessed hemodynamic parameters and systemic inflammation throughout the study. After 72 h, we evaluated incidence of microbiological/histological VAP and brain injury. Petechial hemorrhages score was greater in the TP group (P = 0.013). Analysis of the dentate gyrus showed higher cell apoptosis and deteriorating neurons in TP animals (P < 0.05 vs. the other groups). No differences in systemic inflammation were found among groups. Cerebral perfusion pressure was higher in TP animals (P < 0.001), mainly driven by higher mean arterial pressure. Microbiological/histological VAP developed in 0%, 67%, and 86% of the animals in the TP, control, and IRV-PEEP groups, respectively (P = 0.003). In conclusion, the TP prevents VAP; yet, we found deleterious neural effects in the dentate gyrus, likely associated with cerebrovascular modification in such position. Further laboratory and clinical studies are mandatory to appraise potential neurological risks associated with long-term TP.
Databáze: MEDLINE
Externí odkaz: